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1308 (2) • • �• !o tR`8/ CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER 1-36,r AND FOR s CERTIFICATE OF OCCUPANCY FILL IN BUILDING INSPECTION DIVISION &§7TREET ATTRT$sOF TJECT: % /0J96 . mg.........h.....0...R......................................................... ......... DEPARTMENT USE ONLY Legal Description: Tract.........6$.5.1.... Block............ Lot.......U.......... . Plans Received By........_... (.`r...........................Date ..._ 1��..WDescription of work: Single..F.ami.ly...D.welling...._....._.._...__.........................._................................_..........._..._._�............. REO.: Plans.... Survey.... CALes: Struc..... Energy.... Elect. m .... Mach.... 1st Struct. Improvee?[��t on Parcel:Yes.X No...Area of Bld .'1$6..}1 plans Checked By................a/.`x... ./... Date .... .. Separate Structure./V.o,.., or Addition/Alter tion tp Exisj. BIdg.54.0..G Application Approved By.............. ..Le...........Date .. ..... No. of Stories.......1....... Use of Buildingentia..,__.......,.-... Validated By.......................:......................... . Date ....�,... ..... Valuation of Project: $..105,000........................................................ Compensation Certificate Verified By ..; . ...... Date ....... .. .r Owner: _.BAS. . ......... Phone 2$.2.- ..7.7 oma s,...1n C..................... • • ,• • MIIIIII $ Contractor: ....as...abOVe..............................City Bus. Lic. #11„_,_llff . Contractor's Address: 20823..Stevens..Crk. Phone:..252-.20.7 Permit Fee (plus penalty if-applicable) 294 50 Contractor - Electrical: ..Best...Electrical...Com an ............. Plan Check Fee (less deposit of $.......... Rct. #..........)$....................... City Business License #18.1.72...... Phone:..2K.7-.204 Plumbing: ..Crowle Co......................................................... Energy Plan Check Fee (Dep. of $.,:.,..: Rct. #........) $......... y-� p City Business License #166.41...... Phone%.i4'5-.4.24 Strong Motion Fee .................:........................................$.............7.r.3... Heating and Cooling ......Al...Boyer...Co....-......................... Plumbing Permit Fee ............. . $.....82...0.0..... "� "'.""" ' ”"' City Business License #............ Phone:..Z9.2.-432 Electrical Permit Fee ...ml ^.!.!.........................:..............$..........4.$.,.Q.Q Mach. Htg./Coolg. Permll)$u � $ Architect/Designer: Swallow/Bates...838-.7@IfdmeZl.4._Z5.2- 924 ' Engineer: McKay...$,.Somps............................... Phone985-.0960 Residential Construction Tax ........................................$ .............. B Wells...Far o., ank................................... Unknown Mist. Fee ........................................................................$....................... g ❑ Misc. Fee Lender:I certify that in the performance of the work for which this permit is .....................................................................$................. y employ any person any manner so as to become subject • $ 462.80 issued I shall not emto to the workman's compensation Iowa of Calllornia.',' SIGNATURE OF ZONING • APPLICANT/OWNER ......................................................................... DATE........___....... Environmental Status: Exempt............ Other.._.................................... ......,. •'I rarity that as the applicant I am licensed undethe provisions of the Design Review Approval: Bldg. ............ Site ............ Sign ............ Contractors License Law and further that my Licens, No. ............................ Use Zone ............ P.D. Conditions .................... ................................ in Classification ...................................... Is In full force and effect: or Cond. Use Permit M............ Variance #............ Parking Spaces............ - I certify that I am exempt from the "Licensed Required" provisions of the Contractors License Law. State basis of exemption.) Approved By........................................................... Date ..................__..... I hereby acknowledge that I have read this application and slate that the above is • , • _ <orrcct and agree to comply with all City Ordinances and State Laws regulating building. 1 (We) agree to save, Indemnify and keep harmless the City of Cupertino a croachment Permit........................ Grant of Easement...................... against liabilities, judgments, costa and expenses which may in an way Gutter, Sidewalk, Driveway: Replace.......... Repair.......... acture against said City I onsequence of the granting of this mit." er----------- Conn. Fee $................ Water................ Meter $................ SIGNATURF OF /� Agreement for Completion Of Public Works Improvements .................. APPLICANTICONTRACTO -. .. ...... . DATE . �r Plans Checked By........ Date........ Approved By........ Date........... NOTE! When properly validated this form constitutes a Building Permit. This permit expires and becomes null and void should work not be commenced within APPLICATION s • ELECTRICAL PERMIT 170 days from validation dela, or should authorized constriction be suspended or abandoned for a period of 170 days after work is commenced. PERMIT INSTALLATION NO. EACH FEE APPLICATION • • PLUMBING Light Outlets............ Switches............ Fixtures............ Receptacles............ PERMIT INSTALLATION NO. EACH FEE TOTAL NUMBER (less than 1000 watts) ............ $ •50 Gas System with up to 5 outlets .......:.........................$4.00 Range........ Cooking Unit........ Oven............ ......... ....... 2.00 .............. Each additional outlet ............................................. 1.00............. Dryer........ Garb. Disp......... Dishwasher ............. ....... 2.00 ............ . Water System (Installation, Alt. or Repair) ...1........... 4.00....4.,. b MOTORS: 1 HP or less ........................... ............ ....... . 2.00 Water Closet3. Water Reater.1 Ld. Tray.......1..... ... .. 4.00. �0 r Greeter than 1 HP not more than 5 HP .............. . 3.50 .. ............ Lavatory$.. Shower Pan.l. Bathtub.2. Sink....1........... 3,00. 27.• 0 ............. Temporary Power Pole or Service — 100amp ..........5.00 ............ Wash. Mach..l. Dishwasher...lGarb. Dlsp....1........3..... 3.00. —200 amp. ........ 7.00.................1 1 Sewer ...1dp,Z. ... .d A....................1.................. 8.00.....$.. D Time Clock ................................................... .................. 1.50............ .. Lawn Sprinkler Syd. $5.00 Ea. add Sys. $2.00..................... ............. Misc. (see Ord. current 1...................................................... Vacuum Breakers ............................................ ..............3.50........._.... New Residential Occu pancle5 Flet Rete M Interceptor........ Water Softener........ .............................4.00. .... ... . Plumbing Piping,without fixtures ........1...............1,,,,,,,4.00..... x .0 0-500 sq. ft. $22.00 1501-1750 $34.50............................. Misc. (Sea Ord. Current) .....................................:.............. 501-750 24.60 20 1-•2250 37.60.............................� ,Permit Fee ........................ . ..... . ...... .................... 761-1000 26.00 2001-226C 39.60......... . � p $8,00 TOTAL PLUMBING PERMIT FEE (plus penalty If app. 1001-1250 28.60 ' 2261-2600 az.oo.........2.4:Sb::.::::::::::.�' Cil = 82.00 1261-1600 32.00 2501-2760 49.50.............................. APPLICATION • . HEATING/COOLING Permit Fee...............................................$B.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.p) $ 480 PERMIT INSTALLATION I N0.1 EACH FEE Forced Air Unit..................to 100M ..............................$8.00......... � ' F=Dat over 100M ....................1. . 10.00. 10y ! I„ Comfort Cooling Unit......to 3 ton/HP ........................... 6.00... .........Forms / Foundation ............... . . B e: .'. ... ..... to 15 ton/HP......................... 9.50....Plumbing Ground Work . .................... I. . ... ....." T Rough Electrical ............ ..................{.. .. ... ..:..[.-B.l.. ra to 30 ton/HP........................ ..12.00.............. to 50 ton/HP.......................... 17.00., ams - Plumbing and Healing .......... ................................................... \ fatten a Ener Space Heater........ Wall Heater ................................... 6,00...,_..,...,., 9Y........................... .... ..... ... Flues - Other then bove ........ 3.00..... tlk, .......... Test .. .... .................... 3 .r9 ....I.......................... Vent Fan: Kitchen ..... Bath . ...L�TYeT...I.....5...Ir.. 3.00.....IS 0 mporery Power Gas / Elect. ............. ... .. Commercial Ran a Hootl .l, 8.00...,.., Final - Electrical ........................................ ..�l- eli.�. ...��/�... Range ................................... ` ........ �.. ......... .. 4 Misc. (See Ord. Current............................................................................ Final - Building /Mechanical ................ ..... ....................................... � Permit Fee ...................................................... .... 8.00 Final - Design Review / Landscaping . `... enaap 0) Final-Public Wor � � � � �...���y� � TOTAL Htg./ Caolg. Permit ee (plus opa O� If app. � p.. :.: .. a11++ n swrr 11 -B P,6!h -drw:Grtio S 3_fT Da.,e Locat• on � I I Subject�� /� r Notes E% ��'� _ Approved - Date aoec cr ' ��� /b CITY'OF CUPERTINO COPYE , i GAS SERVICE NOTICE 9 z f 1 , 19 i To- You are hereby authorized to connect/the GAS service for ? Owner or Tenant �o: At New Service' 1 No. of Meters f Reconnect ' I !� No. of Add. Meters Move Service 1 Move/Meter+ PLUMBING INSPECTOR I BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO Bldg.Dept. Office Copy ❑ Backflow Device Sanitary Permit No. P.wSPwer Connection Plumbing Permit No. V •E;�—Plumbing Final Lot No. lD Owner or Tenant - � � /y (� . At r' u 117A �ti44SEf �� /l t Tract Date Connected H �' /�_191-0 Date Final 19 p� I ©" PLUMBING INSPECTOR CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO DATE 19F / BLDG. PERMIT NO. / THE BLDG. LOCATED AT 0 E/JC7 L/ S/4 04r-- �/d S � .��/A'� Com• OWNED BY i HAS BEEN IC "--'--I FOR USE AS � 9 r (ALTERED) F ©M ' ILDING INSPECTOR i ELECTRIC SERVICE NOTICE OFFICE COPY 1 BUILDING INSPECTOR'S NOTICE CITY OF CUPERTINO �•n�l ' 19 !7 J, To You ore herebb uurhhoorized to Connect electrical service for Owner or Tenonr At f t7 I -6 G✓J a L I /�- n t�r� No.of Wires Size of Wires Size of Switch Motor Load Voltage Phase Heating Load K.W. Voltage Llghr I10New Service Reconnect Not of Meters _ _ Heat 120_three Wire More Service No.of Add.Meters Power / T fee Phase Move Meter 0• ELECTRICAL INSPECTOR �-